Utilization Review Manager

Fuller Hospital; Attleboro, Northern (MA, KY); Hybrid; USD 100,000 - 140,000; Full time

Benefits offered by this job

Student Loan Repayment

Tuition Reimbursement

Career development opportunities

Supervision for Licensure

Excellent health plans

Job summary

Fuller Hospital in South Attleboro, Massachusetts, is seeking a Manager of Utilization Review to lead utilization management, case documentation, and payer relationships in a 109-bed psychiatric facility.

The role directs precertification, concurrent and discharge reviews, ensures regulatory compliance, and coordinates with physicians to align payer expectations with patient acuity. This is a full-time, 40-hour-per-week position, offering growth opportunities and licensure supervision.

Qualifications

• Licensure in Massachusetts as a RN or behavioral health clinician.
• Experience leading utilization management and regulatory compliance.
• Knowledge of insurance procedures, billing, and managed care practices.

Responsibilities

• Oversees all utilization management functions.
• Oversees precertification, concurrent, and discharge reviews.
• Ensures proper documentation and allocation of treatment resources.
• Participates in hospital operations meetings driving financial and clinical results.
• Liaises with physicians to align engagement with payer expectations and discharge planning.

Skills

Leadership

Coaching

Time management

Data analytics

Payer relations

Education

Massachusetts RN licensure

LICSW / LCSW / LMHC license

Job description

Responsibilities

Manager of Utilization Review Opportunity -

Fuller Hospital is a 109-bed licensed, private psychiatric facility located in South Attleboro, Massachusetts providing inpatient and outpatient behavioral health services to residents of Massachusetts and Rhode Island. Inpatient units are designed to treat adults with general psychiatric or intellectual disabilities, as well as adolescents with general psychiatric issues. Patients with co-occurring psychiatric and substance abuse disorders can be treated on most units. Fuller Hospital also provides a less intensive Partial Hospitalization Program (PHP) to patients with psychiatric and co-occurring psychiatric and substance abuse disorders.

The Manager of Utilization oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement. This is a full time, 40 hour per week position.

Responsibilities

• Oversees all utilization management functions
• Oversees precertification, concurrent, and discharge utilization reviews
• Facilitates regulatory compliance by ensuring proper documentation and allocation of treatment resources
• Serves as a key member of the hospital management team. Acts as a key participant in hospital operations meetings that drive financial and clinical results
• Functions as a key liaison with all hospital physicians to align physician engagement with payer expectations, patient acuity and discharge planning requirements
• Leads payer engagement activities including post payment reviews, payer audit oversight and denial/appeal oversight
• Manages utilization management staff and performs all administrative department head functions
• Performs other duties as assigned/required by this position

Benefit Highlights

• Student Loan Repayment - $200 per month
• Tuition Reimbursement - $5,000 per year
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off (26 days per year + roll over)
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Supervision for Licensure
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

Headquartered in King of Prussia, PA, Universal Health Services, Inc. (NYSE: UHS) is one of the nation’s largest and most respected providers of hospital and healthcare services. Since our founding in 1979, UHS has grown steadily into a premier Fortune 500® corporation perennially recognized by multiple esteemed national rating entities. Through its subsidiaries, UHS operates inpatient acute care facilities, inpatient behavioral health facilities, outpatient and other facilities, nationwide virtual behavioral health services, an insurance offering, a physician network and various related services with physical locations in the U.S., Puerto Rico, Ireland and United Kingdom. www.uhs.com.

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Qualifications

Requirements

• Licensure: Current Massachusetts licensure as a RN, LCSW, LICSW, or LMHC
• Experience: Three (3) or more years of experience in Utilization Review strongly preferred - At least one (1) year of direct supervisory experience preferred.
• Knowledge/Skills:
  1. Moderate to Expert knowledge of Insurance procedures and terminology as well as Billing procedures and terminology
  2. Basic knowledge of psychiatric and addictive disease diagnosis and treatment. Knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic codes with corresponding clinical assessment skills that support patient evaluation
  3. Leadership skills and ability to provide feedback and coaching to employees
  4. Ability to problem-solve and exercise sound time management
  5. Experience using data to identify trends. Ability to manage team productivity and compliance with required timelines
  6. Knowledge of managed care payer business practices, behavioral health hospital operations and medical necessity determinations

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.